What is a cruciate ligament reconstruction?

 

Anterior cruciate ligament tear causes feeling of giving way in most people and they feel they cannot rely on their knee. Some people can recover good knee function without surgery, although most have to adjust their activity level such as giving up sports involving twisting on the knee.

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Do I need a cruciate ligament reconstruction?

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ACL reconstruction may become necessary if you experience ongoing instability symptoms after having torn your anterior cruciate ligament. If you have a repairable meniscus injury it is advised that you have both done at the same time to protect the meniscal repair.

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What are the benefits?

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• The range of movement returns to normal with 4-6 weeks. The initial swelling should also settle down during this time.

• Your knee should feel more stable so you can rely on it when doing sports or heavy physical work.

• You can return to non-contact, sport specific training after 6 months and full contact after 9 months following your surgery. At this point the risk of a re-tear is similar to a normal knee.

• If your knee is stable this protects the cartilage surfaces and the meniscus so you will be less likely to develop arthritis in the long run.

 

What is involved?

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• Preparing for your operation

  • We need to make sure you are as fit and prepared as possible to minimise the risk of complications and to ensure a speedy and smooth recovery. You will have a pre-assessment to identify any correctable abnormalities such as high blood pressure, anaemia​ and diabetes. We advise that you stop smoking and try to loose weight if applicable. Your BMI tells you if you are overweight. 

  • We will ask you to take part in an exercise program called pre-habilitation. This is designed to get your knee muscles in the best possible shape so your recovery is smoother.

• Surgical procedure

  • ACL reconstruction requires a general anaesthetic and the consultant carrying this out will discuss the details with you on the day.

  • ACL reconstruction is a keyhole procedure, but the tendons used need to be harvested through a small incision over the shin. We usually take one or two of the hamstring tendons from behind the knee to use as grafts to replace the torn ACL. Small tunnels are created in the thigh and shin bones and the graft is fixed in them using a small metal button at the top and a screw at the bottom.

• Recovery

  • This operation is usually done as day case surgery. You should be able to walk with crutches a few hours after the procedure. Physiotherapy is an integral part of the treatment. We will give you an exercise program for home and your physiotherapist will assess your progress regularly.

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What are the risks?​​​

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• In some cases, although the knee feels more stable a degree of laxity still remains. Even in an ideal world the strength of the knee only returns to about 90% of the pre-injury level and some people cannot return to the same level of sporting activity as before.

• Infection is a major complication which may only need a course of antibiotics, but in a worst case scenario a second operation may become necessary to clear it.

• Significant bleeding is uncommon, but should it occur and does not stop you may need to return to the operating theatre.

• Nerve injury causing numbness in the front of the shin can occur, but usually improves over time. 

• Blood clots can form in the deep veins of the leg which block the blood flow back to the heart causing pain and swelling of the leg. On occasions a clot can break free, travel to the lungs and cause a blockage of the arteries of the lung. Rarely, this can be fatal. We may give you blood thinners to reduce this risk and ask you to exercise your calf muscles regularly.